Healthcare Provider Details

I. General information

NPI: 1306097886
Provider Name (Legal Business Name): SOUTHWEST NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 W ROYAL PALM RD
PHOENIX AZ
85021-4916
US

IV. Provider business mailing address

2700 N CENTRAL AVE SUITE 1050
PHOENIX AZ
85004-1133
US

V. Phone/Fax

Practice location:
  • Phone: 602-269-5300
  • Fax: 602-269-5380
Mailing address:
  • Phone: 602-266-8402
  • Fax: 602-264-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberOTC6787
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberOTC6787
License Number StateAZ

VIII. Authorized Official

Name: MS. AMY B. HENNING
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 602-285-4340